| NPI | 1801513148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0007670) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-10-27 |
| Last Update Date | 2023-08-30 |