| NPI | 1427650316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 50.006740RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.006740RX) |
| 363AM0700X Physician Assistant, Medical (Licence: CO PA.0007590) | |
| Enumeration Date | 2020-11-15 |
| Last Update Date | 2023-09-21 |