| NPI | 1982149845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004911) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: CO PA.0004911) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004911) | |
| Enumeration Date | 2017-01-03 |
| Last Update Date | 2024-02-28 |