| NPI | 1144370933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0000722) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA20750) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2016-10-17 |