NPI | 1336510445 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004437) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO PA.00004437) |
Enumeration Date | 2015-10-14 |
Last Update Date | 2023-12-12 |