| NPI | 1790149086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: CT 79300) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NY 295509) |
| 208600000X Surgery (Licence: NY 295509) | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2026-02-11 |