| NPI | 1316650526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14600) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MN 14600) |
| Enumeration Date | 2023-01-03 |
| Last Update Date | 2024-09-18 |