| NPI | 1225064868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ND PAC0474) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 9529) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2016-03-22 |