| NPI | 1669679486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 10293) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 10293) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2023-03-07 |