| NPI | 1578997425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0004716) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA TMA052810) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2016-10-04 |