| NPI | 1194487355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2023-0210) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM PA2023-0210) |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2023-11-07 |