| NPI | 1962945741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.004926RX) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IN 10004780A) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2025-04-09 |