| NPI | 1396719514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 1710) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO 1710) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2024-07-26 |