| NPI | 1447780853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0005078) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0005078) |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CO PA.0005078) | |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2024-03-22 |