| NPI | 1982032967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA0003809) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 3809) |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2023-04-18 |