| NPI | 1720360928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0005300) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA21611) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2018-10-30 |