NPI | 1881934818 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0003587) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO PA0003587) |
Enumeration Date | 2013-02-28 |
Last Update Date | 2023-01-31 |