| NPI | 1649248188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA2919) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA3011) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2021-05-04 |