NPI | 1194947325 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 1773) |
Enumeration Date | 2007-05-03 |
Last Update Date | 2023-03-07 |