NPI | 1851938310 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0005987) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2019-12-04 |
Last Update Date | 2020-11-09 |