NPI | 1780125195 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14193) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-03-17 |
Last Update Date | 2022-10-05 |