| NPI | 1982707964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0002538) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NM 99PA29) |
| 363AM0700X Physician Assistant, Medical (Licence: NM 99PA29) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2016-06-23 |