| NPI | 1184699464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CO PA.0006241) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: FL PA2946) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2020-09-26 |