| NPI | 1447640842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2017021) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2015-01-23 |
| Last Update Date | 2023-08-21 |