| NPI | 1407491574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0007814) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 58256) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2023-07-03 |