| NPI | 1396747630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TX E5010) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX E5010) |
| 2086S0129X Surgery, Vascular Surgery (Licence: TX E5010) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2015-01-20 |