| NPI | 1538360946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0003513) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085002972) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2016-03-22 |