NPI | 1801251582 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0008423) |
Enumeration Date | 2015-12-22 |
Last Update Date | 2024-09-04 |