| NPI | 1265552210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0004075) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AK 689) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2020-03-06 |