| NPI | 1588898035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 10630) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 2473-23) |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2018-03-17 |