| NPI | 1962090142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006783) |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: CO PA.0006783) |
| 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0006783) | |
| Enumeration Date | 2021-01-04 |
| Last Update Date | 2025-06-18 |