| NPI | 1629549407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0006086) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: CO PA0006086) |
| Enumeration Date | 2018-12-05 |
| Last Update Date | 2025-10-17 |