NPI | 1013507730 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0006651) |
Enumeration Date | 2021-01-26 |
Last Update Date | 2023-09-08 |