| NPI | 1376217273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 1185084) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 1185084) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2022-02-14 |