| NPI | 1538403498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0003797) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO 0003797) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2020-01-29 |