| NPI | 1033627344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006265) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AL 1338) |
| Enumeration Date | 2018-01-21 |
| Last Update Date | 2020-07-23 |