| NPI | 1124104138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NY 198637) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NJ 25MA06186400) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2020-11-30 |