NPI | 1538957949 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0009186) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2025-04-26 |
Last Update Date | 2025-06-24 |