| NPI | 1942245857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA18054) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA PA18054) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: CA PA18054) | |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2024-06-21 |