| NPI | 1326021064 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TN 20442) | 
| Additional Taxonomies | 208600000X Surgery (Licence: TN 20442) | 
| Enumeration Date | 2005-11-28 | 
| Last Update Date | 2023-07-24 |