| NPI | 1699141796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004350) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0004350) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2018-10-18 |