NPI | 1609534098 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0008063) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AS0400X Physician Assistant, Surgical (Licence: CO PA.0008063) | |
Enumeration Date | 2021-12-02 |
Last Update Date | 2024-06-19 |