| NPI | 1235455213 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: FL MFC1652) | 
| Additional Taxonomies | 2086S0129X (Licence: FL MFC1652) | 
| Enumeration Date | 2010-04-15 | 
| Last Update Date | 2012-05-01 |