| NPI | 1093733693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ND PAC0208) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 9599) |
| 363AM0700X Physician Assistant, Medical (Licence: ND PAC0208) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2016-04-18 |