| NPI | 1518021948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MN 10884) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WI 3505-23) |
| 363AS0400X Physician Assistant Surgical (Licence: AK 536) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2018-10-22 |