| NPI | 1891797528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004349) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 1706-023) |
| 363A00000X Physician Assistant (Licence: CO PA.0004349) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2023-08-29 |