NPI | 1699802926 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2020-0008) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NV 421) |
Enumeration Date | 2007-02-27 |
Last Update Date | 2020-03-04 |