| NPI | 1417270786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 3856) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SD 0739) |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2013-11-08 |