| NPI | 1104182427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: FL ME119375) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A107291) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2021-07-22 |