NPI | 1760404693 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA0003466) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 3279) |
Enumeration Date | 2006-07-23 |
Last Update Date | 2014-04-22 |