| NPI | 1407016439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: KS 04-36350) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 94-07038) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2022-06-14 |