| NPI | 1811864630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0009419) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CO 0009419) |
| Enumeration Date | 2025-10-17 |
| Last Update Date | 2025-11-17 |