| NPI | 1881174548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2020-0048) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2023-11-30 |