| NPI | 1184967234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CO PA.0005881) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MD C0004874) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2020-04-01 |