| NPI | 1447287271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 1351) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 10545) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2024-01-29 |