| NPI | 1891316089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006295) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 0006295) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2024-09-13 |