| NPI | 1932136686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0003524) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 3305) |
| 363A00000X Physician Assistant (Licence: CO 3524) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2020-11-25 |