| NPI | 1205835493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: AZ 23299) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 32737) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2017-01-16 |