| NPI | 1417962259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 1373) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 4522) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2024-06-14 |