| NPI | 1154521490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TX D0123) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX D0123) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2010-07-21 |