| NPI | 1942949136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.007594RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH APP-000599950) |
| Enumeration Date | 2022-06-03 |
| Last Update Date | 2022-07-29 |