| NPI | 1790124857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: KY 61040) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP02786) |
| 208600000X Surgery (Licence: KY TP296) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2025-07-18 |