| NPI | 1710221841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 6664) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: GA 6664) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2024-08-15 |