NPI | 1992113963 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11833) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5736) |
Enumeration Date | 2014-07-23 |
Last Update Date | 2020-10-09 |