| NPI | 1366214744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 8451726-1206) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: UT 8451726-1206) |
| Enumeration Date | 2023-10-27 |
| Last Update Date | 2024-03-04 |