| NPI | 1841957396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NM PA2023-0238) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-11-19 |
| Last Update Date | 2024-11-24 |