| NPI | 1932137411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0005783) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO PA.0005783) |
| 207P00000X Emergency Medicine (Licence: CA PA18072) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2019-07-24 |