| NPI | 1891710273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 1944) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WV 526) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2010-03-02 |