| NPI | 1750858916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0007220) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 004400) |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 004400) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2022-04-25 |