| NPI | 1144033267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 15399) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 8413.23) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2025-01-31 |
| Last Update Date | 2025-09-08 |