| NPI | 1285227272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2021-0077) |
| Enumeration Date | 2021-02-19 |
| Last Update Date | 2025-02-20 |