| NPI | 1801504303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 11225) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: GA 11225) |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2022-12-30 |