| NPI | 1326690678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006891) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO PA.0006891) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CO PA.0006891) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2024-05-10 |