| NPI | 1881019925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0008078) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 002413) |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2024-01-18 |