| NPI | 1962851816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.008510RX) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2024-11-08 |