| NPI | 1427727957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0009054) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 4595) |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2025-06-13 |