| NPI | 1528466703 |
|---|---|
| Former Name | ANDREW JONATHAN OTT |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0004683) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2014-12-20 |
| Last Update Date | 2016-07-06 |