NPI | 1003899527 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 9151) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 9151) |
363AM0700X Physician Assistant, Medical (Licence: WI 797) | |
Enumeration Date | 2005-11-29 |
Last Update Date | 2021-11-04 |