| NPI | 1992996060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3657) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2010-0015) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2024-11-22 |