NPI | 1740912096 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14814) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 7776-23) |
Enumeration Date | 2022-06-27 |
Last Update Date | 2024-03-12 |