| NPI | 1598757700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0000109) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: DE C5-0000109) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2021-10-13 |