| NPI | 1588816722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0003032) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9104817) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2014-05-06 |