| NPI | 1265716302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006455) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA21797) |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2023-06-05 |