NPI | 1124573423 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12266) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2016-08-17 |
Last Update Date | 2020-10-09 |