| NPI | 1447986914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NM PA2024-0071) |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2024-07-17 |