NPI | 1356322762 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2002-0028) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NM PA2002-0028) |
Enumeration Date | 2005-11-11 |
Last Update Date | 2018-03-17 |