| NPI | 1184189425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0006103) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO PA.0006103) |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2024-01-03 |