| NPI | 1942488200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0002585) |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2018-11-21 |