| NPI | 1740695808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN238024) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: GA RN238024) |
| 208600000X Surgery (Licence: GA RN238024) | |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2023-10-20 |