| NPI | 1699117101 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TX 76030) | 
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: IL 036135491) | 
| 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35c.000928) | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: OH 35c.000928) | |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2013-07-25 | 
| Last Update Date | 2025-06-12 |