| NPI | 1750441440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO 2430) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA01722) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2015-06-05 |