NPI | 1689228397 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0007251) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 026088) |
Enumeration Date | 2019-07-31 |
Last Update Date | 2025-07-24 |