NPI | 1124251418 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 10673) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 1318) |
Enumeration Date | 2009-09-02 |
Last Update Date | 2020-11-10 |