NPI | 1679510887 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0002045) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 2045) |
Enumeration Date | 2006-05-31 |
Last Update Date | 2023-04-25 |