| NPI | 1427000751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 301) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA0004597) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2021-02-19 |