NPI | 1891394334 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0006542) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2020-10-24 |
Last Update Date | 2021-03-05 |