NPI | 1891482360 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0007841) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0007841) |
Enumeration Date | 2023-04-24 |
Last Update Date | 2023-08-04 |