| NPI | 1538487178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004870) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA 60466519) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2021-02-18 |