| NPI | 1215384961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004725) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 0000) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2018-10-19 |