| NPI | 1740228675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0001585) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO 1585) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60795056) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2022-06-13 |