| NPI | 1417950114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TX D5061) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: TX D5061) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2011-01-31 |