| NPI | 1821134644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO 4256) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA AP2155) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2021-07-14 |