| NPI | 1003869249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: KS 1501434) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: IN 10001625A) |
| 363AS0400X Physician Assistant, Surgical (Licence: NE 493) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2024-11-19 |