| NPI | 1225040033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 850) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: CO PA.0000850) | |
| 363A00000X Physician Assistant (Licence: CO 00008530) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2020-06-01 |