| NPI | 1356465371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 2988) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM PA2005-18) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2021-05-20 |