| NPI | 1396898169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CO PA-2548) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA18794) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2019-06-12 |