| NPI | 1306258264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: OH 35.155733) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT206843) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2026-08-03 |