| NPI | 1891706867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50002339) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: OH 2339) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2011-04-25 |