NPI | 1841513504 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ND PAC0540) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: SD 0736) |
Enumeration Date | 2010-03-10 |
Last Update Date | 2023-04-26 |