| NPI | 1942266937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: OH 50002035) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.002035RX) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2021-01-07 |