| NPI | 1801193313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10963) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 10963) |
| Enumeration Date | 2011-02-17 |
| Last Update Date | 2023-11-01 |