| NPI | 1558685834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10729) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 1389) |
| Enumeration Date | 2010-03-16 |
| Last Update Date | 2023-10-05 |