| NPI | 1508127036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NY 288322) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP02613) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2020-07-13 |