NPI | 1568204386 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14954) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2024-06-11 |
Last Update Date | 2024-09-25 |