| NPI | 1760427280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006093) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-002254) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2022-12-13 |