| NPI | 1417180324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX N7389) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TX N7389) |
| 207P00000X Emergency Medicine (Licence: TX N7389) | |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2014-10-08 |