| NPI | 1174559231 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: FL ME135932)  | 
| Additional Taxonomies | 174400000X Specialist (Licence: NY 224040-1)  | 
| 2086S0129X  (Licence: NY 224040)  | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NY 224040)  | |
| Enumeration Date | 2006-06-23 | 
| Last Update Date | 2022-01-31 |