| NPI | 1760072847 |
|---|---|
| Other Name | BRAD JOHNSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2022-0038) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-01-22 |
| Last Update Date | 2022-06-13 |