| NPI | 1598855991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 2043) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 5121596-1206) |
| 363A00000X Physician Assistant (Licence: NE 1289) | |
| Enumeration Date | 2006-10-14 |
| Last Update Date | 2019-02-06 |