| NPI | 1306819941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ND PAC0596) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 12819) |
| 363A00000X Physician Assistant (Licence: WA PA10003354) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2020-01-06 |