| NPI | 1982643599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA 1691) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO 1691) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2013-02-14 |