| NPI | 1750348421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 85777) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: SC 85777) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: SC 85777) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2025-07-08 |