| NPI | 1154548824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA-1719) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO 1719) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2012-05-30 |