| NPI | 1316605017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2021-0110) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM PA2021-0110) |
| Enumeration Date | 2021-11-30 |
| Last Update Date | 2023-08-02 |