NPI | 1427408251 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1610) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 4759) |
Enumeration Date | 2016-06-13 |
Last Update Date | 2023-09-08 |