| NPI | 1740648070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0006691) |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2025-07-11 |