| NPI | 1609207976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0004339) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0005166) |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2022-02-08 |