| NPI | 1902835614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA1667) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO 1667) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2024-08-05 |