| NPI | 1396375531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0007286) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2021-0071) |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2024-10-23 |