| NPI | 1144679093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 12197) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 2533) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2020-09-18 |