| NPI | 1366718603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: LA 008497) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 008497) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: LA 008497) | |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2012-03-30 |