| NPI | 1265076855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14312) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0110007874) |
| 363A00000X Physician Assistant (Licence: VA 0110007874) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-11-06 |
| Last Update Date | 2023-01-20 |