| NPI | 1922741057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CO PA.0007518) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-04-17 |
| Last Update Date | 2024-05-17 |