NPI | 1376277541 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0008309) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2022-07-13 |
Last Update Date | 2024-02-20 |