| NPI | 1013154962 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: AL 32540)  | 
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NC 2010-00830)  | 
| Enumeration Date | 2009-01-14 | 
| Last Update Date | 2024-02-01 |