NPI | 1265212906 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: NV PA3053) |
Additional Taxonomies | 208VP0000X (Licence: CO PA.0008285) |
363A00000X Physician Assistant (Licence: CO PA.0008285) | |
Enumeration Date | 2023-10-02 |
Last Update Date | 2025-06-17 |