| NPI | 1093321267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0007074) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 8096) |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2023-11-09 |