| NPI | 1760647002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0003143) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NV PA740) |
| 363AM0700X Physician Assistant, Medical (Licence: CO 3143) | |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2023-06-02 |