| NPI | 1699910893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0002233) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1070747) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2022-04-22 |