| NPI | 1033701370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: SC MPA.5609) |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2025-07-10 |