| NPI | 1134309099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: CA PA51593) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001835) |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA51593) | |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2020-10-24 |