| NPI | 1255979225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0007592) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AL 1543) |
| Enumeration Date | 2019-12-20 |
| Last Update Date | 2024-10-31 |