| NPI | 1225296106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: CA 108856) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 245402) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2018-12-17 |