| NPI | 1851827422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1153378) |
| 363A00000X Physician Assistant (Licence: CO PA.0006779) | |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2023-08-09 |