| NPI | 1982317566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.008648RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601012306) |
| Enumeration Date | 2022-12-28 |
| Last Update Date | 2024-02-13 |