| NPI | 1376000505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0008086) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 56473) |
| Enumeration Date | 2019-02-24 |
| Last Update Date | 2024-08-12 |