| NPI | 1467861310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 11507) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: GA 11507) |
| 363A00000X Physician Assistant (Licence: NY 017823) | |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2023-11-20 |