| NPI | 1700215993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0004210) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0004210) |
| 363A00000X Physician Assistant (Licence: CT 2945) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 017155-1) | |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2018-10-18 |