| NPI | 1538738232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CO PA0007945) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MA062573) |
| 207Q00000X Family Medicine (Licence: CO PA0007945) | |
| 363AM0700X Physician Assistant Medical (Licence: PA MA062573) | |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2023-11-03 |