NPI | 1013165638 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 10477) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 1169- temp) |
Enumeration Date | 2008-09-08 |
Last Update Date | 2022-03-03 |