| NPI | 1144317637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2006-0034) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NM PA20060034) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2015-01-13 |