NPI | 1235462813 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA-2907) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2009-09-14 |
Last Update Date | 2014-04-10 |