| NPI | 1790149086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NY 295509) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 295509) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NJ 25MA11509800) | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2024-11-12 |