| NPI | 1902492093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2022-0074) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM PA2022-0074) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2024-10-05 |