| NPI | 1457495244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0000254) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 254) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2016-12-27 |