| NPI | 1619223724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0003475) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO 3475) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2023-04-04 |