| NPI | 1427367895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0006303) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 5546) |
| 363A00000X Physician Assistant (Licence: CO PA.0006303) | |
| 363AM0700X Physician Assistant, Medical (Licence: SD 0755) | |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2023-11-14 |