| NPI | 1962701094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NY 299359) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OTO13171) |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2019-10-24 |