| NPI | 1841237591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO 00610) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 3160) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2017-01-10 |