| NPI | 1629199492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0003720) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: OR PA00843) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2024-09-04 |