| NPI | 1851813935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006679) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 091626) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2022-01-18 |