| NPI | 1770509663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 9283) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN MN9283) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2023-03-16 |