| NPI | 1780040949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12028) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 12028) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2024-10-28 |