| NPI | 1265271621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0008695) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2024-08-16 |