| NPI | 1043375959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 10184) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ND PAC1023) |
| 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004104) | |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2024-09-12 |