| NPI | 1639414550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NY 284767) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 284767) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 284767) | |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2023-07-07 |