| NPI | 1609047851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0002575) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO PA2575) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2023-11-20 |