| NPI | 1215093539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0005304) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA05097) |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA05097) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2024-01-18 |