NPI | 1780933978 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0005239) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2012-09-04 |
Last Update Date | 2021-12-15 |