| NPI | 1093251712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004895) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 54153) |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2023-05-26 |