| NPI | 1952345852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50003214) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 103109) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2024-12-17 |