| NPI | 1831731819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0006008) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0006008) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00622100) | |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2024-10-28 |