NPI | 1033634001 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12851) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C06566) |
Enumeration Date | 2017-08-10 |
Last Update Date | 2020-10-09 |