| NPI | 1952679136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.003442) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 8912) |
| 363A00000X Physician Assistant (Licence: FL PA9107975) | |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2025-12-09 |