| NPI | 1356829774 |
|---|---|
| Former Name | ZACHARY ALLEN RUNGE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 310190) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: LA 310190) |
| 363AM0700X Physician Assistant, Medical (Licence: LA 310190) | |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2018-12-10 |