| NPI | 1043763469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0006528) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0006528) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 019967) | |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2023-10-31 |