| NPI | 1457519837 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TX U1229) | 
| Additional Taxonomies | 208600000X Surgery (Licence: NC 149176) | 
| Enumeration Date | 2008-06-02 | 
| Last Update Date | 2024-03-13 |