| NPI | 1851676340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0005171) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL pa9105727) |
| 363AM0700X Physician Assistant, Medical (Licence: FL pa9105727) | |
| Enumeration Date | 2011-10-15 |
| Last Update Date | 2018-03-17 |