| NPI | 1851025183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 15537) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 363A00000X Physician Assistant (Licence: UT 13034857-1206) | |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2026-01-19 |