| NPI | 1003902081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A32269) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A32269) |
| 2086S0129X Surgery, Vascular Surgery (Licence: CA A32269) | |
| 208C00000X Colon & Rectal Surgery (Licence: CA A32269) | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: CA A32269) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2023-02-27 |