| NPI | 1831376334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 3193) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA 19545) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2015-11-04 |