| NPI | 1992951875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.002627RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10002010A) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2016-11-23 |