NPI | 1851321434 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 9585) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 9585) |
Enumeration Date | 2006-07-03 |
Last Update Date | 2011-12-22 |