| NPI | 1891741351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.002199RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 51990856) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2023-12-27 |