NPI | 1720450646 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0004438) |
363AS0400X Physician Assistant Surgical (Licence: CO PA.0004438) | |
Enumeration Date | 2015-10-30 |
Last Update Date | 2024-05-29 |