| NPI | 1750794194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NY 298768-01) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 298768) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2023-07-12 |