| NPI | 1497901409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO PA.0002636) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CO PA.0002636) |
| 363AS0400X Physician Assistant, Surgical (Licence: CO PA2636) | |
| Enumeration Date | 2008-08-10 |
| Last Update Date | 2024-10-08 |