NPI | 1861840993 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0005328) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA15667) |
363A00000X Physician Assistant (Licence: NV PA2614) | |
363A00000X Physician Assistant (Licence: ID PA-2189) | |
Enumeration Date | 2016-05-31 |
Last Update Date | 2022-04-28 |