NPI | 1407559370 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 15010) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 8039) |
Enumeration Date | 2023-03-22 |
Last Update Date | 2024-10-16 |