| NPI | 1548371826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10331) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2898-23) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2024-04-05 |