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 | 2017-01-24 |