| 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 |