| NPI | 1841591344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13587) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.003911) |
| Enumeration Date | 2010-11-15 |
| Last Update Date | 2021-07-07 |