NPI | 1508610072 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14973) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
208800000X Urology (Licence: MN 14973) | |
Enumeration Date | 2024-04-12 |
Last Update Date | 2024-08-21 |