| NPI | 1508408782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0006362) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OK 3178) |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2024-03-25 |