NPI | 1962090142 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006783) |
Additional Taxonomies | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: CO PA.0006783) |
363AS0400X Physician Assistant, Surgical (Licence: CO PA.0006783) | |
Enumeration Date | 2021-01-04 |
Last Update Date | 2025-06-18 |