| NPI | 1053327783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2003-0007) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM PA2003-0007) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2013-08-06 |