| NPI | 1861906299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0007707) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 089259) |
| Enumeration Date | 2017-11-21 |
| Last Update Date | 2023-03-20 |