| NPI | 1043270952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 9938) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 2556-23) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2020-10-02 |