NPI | 1558187757 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.8978) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2024-12-03 |
Last Update Date | 2025-03-06 |