| NPI | 1710520937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006894) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM PA2020-0091) |
| 363AM0700X Physician Assistant, Medical (Licence: NM PA2020-0091) | |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2022-03-26 |