| NPI | 1821502154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12593) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 12595) |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2021-03-11 |