| NPI | 1730393232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: NC 29693) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NC 29693) |
| 208600000X Surgery (Licence: NC 29693) | |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2013-07-30 |