| NPI | 1427218916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO 0004966) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NM PA20190010) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2020-08-29 |