| NPI | 1659729226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004664) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0004664) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2022-10-26 |