| NPI | 1942583687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 50.004515RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA055068) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2025-12-18 |