| NPI | 1013194380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY JATANA Representative 303-944-4085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CO 2612) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2010-06-17 |