NPI | 1205612595 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0008134) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0008134) |
Enumeration Date | 2023-09-04 |
Last Update Date | 2023-10-04 |