| NPI | 1952117590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO 8782) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0008782) |
| Enumeration Date | 2024-12-09 |
| Last Update Date | 2025-06-25 |