| NPI | 1952390551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH OH-1576) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 50.001576) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2023-02-28 |