| NPI | 1982051199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006141) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 53682) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2025-04-23 |