| NPI | 1194367862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NM PA2019-0088) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 1194827535) |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2024-09-12 |