| NPI | 1174649396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 4258) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA10334) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2015-12-18 |