NPI | 1225125370 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0000689) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO 689) |
Enumeration Date | 2006-10-09 |
Last Update Date | 2018-10-16 |