| NPI | 1265405708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004872) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00008865) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2021-05-18 |