NPI | 1699730531 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10979) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 10979) |
Enumeration Date | 2006-04-20 |
Last Update Date | 2016-03-29 |