NPI | 1174649396 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 4258) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA10334) |
Enumeration Date | 2007-03-21 |
Last Update Date | 2015-12-18 |