NPI | 1528239563 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CO PA.0001477) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 1477) |
Enumeration Date | 2008-03-18 |
Last Update Date | 2018-10-23 |