| NPI | 1598934481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2007-0044) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 61498) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2023-06-16 |