NPI | 1942759998 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0005933) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0005933) |
Enumeration Date | 2016-09-30 |
Last Update Date | 2021-08-18 |