| NPI | 1023596921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA9129) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NY 023460) |
| 363A00000X Physician Assistant (Licence: NY 023460) | |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2023-01-06 |