| NPI | 1801129606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0005215) |
| Additional Taxonomies | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic |
| 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0005215) | |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2023-06-05 |