| NPI | 1235110982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: MA 218867) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD047363L) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2011-05-09 |