| NPI | 1316289952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0004717) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2020-01-31 |