| NPI | 1609354893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12750) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MN 941475) |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2021-08-23 |