| NPI | 1942758917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004790) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 0004790) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2020-09-22 |