| NPI | 1912169723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004518) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA21434) |
| 363A00000X Physician Assistant (Licence: CO PA 0004518) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NV PA1106) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2023-11-14 |