| NPI | 1396375531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM PA2021-0071) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2021-0071) |
| 363AM0700X Physician Assistant Medical (Licence: CO PA.0007286) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2023-10-27 |