| NPI | 1275646044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: FL ME108127) |
| Additional Taxonomies | 208600000X Surgery (Licence: PR 8778) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2015-03-24 |