NPI | 1417538174 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14162) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 56010440) |
Enumeration Date | 2021-04-15 |
Last Update Date | 2023-01-03 |