| NPI | 1447555016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CO TL.0009385) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA175899) |
| 363A00000X Physician Assistant (Licence: CO PA0003147) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-01-12 |
| Last Update Date | 2022-09-14 |