| NPI | 1902248255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0005081) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CO PA.0005081) |
| 363AM0700X Physician Assistant, Medical (Licence: MD C0005146) | |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2022-11-10 |