| NPI | 1639391634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA18554) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: CA PA18554) |
| 363A00000X Physician Assistant (Licence: CA PA18554) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2024-08-06 |