| NPI | 1053302257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: CA G88362) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA64383) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2015-12-08 |