| NPI | 1336286939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA001625L) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: PA MA0016251) |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110003469) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2019-08-30 |