| NPI | 1427338441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006370) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 4865) |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2021-02-18 |