| NPI | 1164915054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006265) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: VA 0110006265) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: VA 0110006265) | |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2025-11-19 |