NPI | 1740632355 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14420) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 2727) |
363A00000X Physician Assistant | |
Enumeration Date | 2016-07-07 |
Last Update Date | 2023-05-17 |