| NPI | 1043202450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: WA MD00019557) |
| Additional Taxonomies | 2086S0129X (Licence: WA MD00019557) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2025-09-11 |