NPI | 1811966385 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0001279) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KS 15-00965) |
363AM0700X Physician Assistant, Medical (Licence: NM PA2010-0073) | |
Enumeration Date | 2006-03-16 |
Last Update Date | 2014-04-24 |