NPI | 1063433993 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10155) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 891) |
Enumeration Date | 2006-07-23 |
Last Update Date | 2020-08-21 |