| NPI | 1346289956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 1567) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO PA-1567) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2022-09-29 |