NPI | 1255619813 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11508) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 11508) |
363AS0400X Physician Assistant, Surgical (Licence: MN 11508) | |
Enumeration Date | 2011-08-01 |
Last Update Date | 2020-10-01 |