| NPI | 1235164617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: MA 75701) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 75701) |
| 2086S0129X Surgery Vascular Surgery (Licence: MA 75701) | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: MA 75701) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2008-01-14 |