| NPI | 1972827129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 50003026) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50003026) |
| Enumeration Date | 2010-03-17 |
| Last Update Date | 2010-03-17 |