NPI | 1194101147 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11953) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2015-07-31 |
Last Update Date | 2020-10-09 |