| NPI | 1306973367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 817) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO 817) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2021-05-14 |