| NPI | 1104974641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: LA 017580) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 19445) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2012-09-07 |