| NPI | 1932110467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0005326) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA07845) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2020-06-01 |