| NPI | 1447203443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0003517) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085002134) |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085002134) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2024-03-07 |