| NPI | 1316099286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 2455) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003530A) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2024-12-18 |