| NPI | 1164764338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: MA 265022) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 256679) |
| 208600000X Surgery (Licence: MA 265022) | |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2023-07-17 |