| NPI | 1447652581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0008274) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1118476) |
| Enumeration Date | 2014-09-19 |
| Last Update Date | 2024-04-01 |