NPI | 1437230844 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2006-0046) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NM PA2006-0046) |
363AS0400X Physician Assistant, Surgical (Licence: NM PA2006-0046) | |
Enumeration Date | 2006-10-18 |
Last Update Date | 2007-10-01 |