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 |