| NPI | 1174902019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0004705) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO 0004705) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2018-10-19 |