| NPI | 1740615558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CO PA.0005001) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CA 23128) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2022-01-03 |