NPI | 1093144339 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2013-0078) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NM PA2013-0078) |
Enumeration Date | 2013-11-07 |
Last Update Date | 2025-09-10 |