| NPI | 1033614730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55378) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CO PA.0008047) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2023-11-07 |