| NPI | 1659786929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ND PAC0558) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: ND PAC0558) | |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2025-04-29 |