NPI | 1356485072 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO 301) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO 301) |
Enumeration Date | 2007-02-16 |
Last Update Date | 2016-05-06 |