| NPI | 1679562987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0003788) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2016-07-28 |