NPI | 1689104986 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12466) |
Additional Taxonomies | 207N00000X Dermatology (Licence: MN 12466) |
Enumeration Date | 2017-06-19 |
Last Update Date | 2024-03-01 |