| NPI | 1851445936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 1277) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO PA 801) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2018-03-16 |