| NPI | 1881641975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX F1391) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX F1391) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TX F1391) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2020-09-29 |