| NPI | 1487636106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NC 2005-00900) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2005-00900) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2023-03-07 |