| NPI | 1902516636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 50.008252RX) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 50.008252RX) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2024-11-21 |