| NPI | 1467648626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006509) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA053067) |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2024-07-10 |