| NPI | 1801251582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0008423) |
| Enumeration Date | 2015-12-22 |
| Last Update Date | 2024-09-04 |