NPI | 1629380241 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10803) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 1441) |
Enumeration Date | 2010-07-12 |
Last Update Date | 2020-10-09 |