| NPI | 1952999088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9116420) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: FL PA9116420) |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2026-07-23 |