NPI | 1912983941 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 9201) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 22301) |
Enumeration Date | 2005-12-21 |
Last Update Date | 2024-01-18 |