NPI | 1184895948 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2016-0027) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-01302) |
Enumeration Date | 2008-03-19 |
Last Update Date | 2021-02-18 |