NPI | 1265104764 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 13862) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 13862) |
Enumeration Date | 2021-10-02 |
Last Update Date | 2024-11-10 |