| NPI | 1972859403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NM PA2012-0021) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA60796883) |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2021-01-18 |