NPI | 1144603234 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2015-0037) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NM PA2015-0037) |
Enumeration Date | 2015-07-07 |
Last Update Date | 2018-11-29 |