NPI | 1215057682 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0003901) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA04206) |
Enumeration Date | 2007-03-30 |
Last Update Date | 2024-09-05 |