| NPI | 1487326898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0008172) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 5550) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2023-11-08 |