| NPI | 1326147455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 2136) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2021-0085) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA0016431) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NM PA2021-0085) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2024-01-04 |