| NPI | 1346251527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10779) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ND 694) |
| 111N00000X Chiropractor (Licence: MN 4088) | |
| 363A00000X Physician Assistant (Licence: MN 1435) | |
| 363AM0700X Physician Assistant, Medical (Licence: ND PAC0588) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2024-02-08 |