| NPI | 1679743439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0005255) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 3743) |
| Enumeration Date | 2008-03-08 |
| Last Update Date | 2019-06-17 |