| NPI | 1962718841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0003389) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO 3389) |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2022-01-12 |