| NPI | 1518904507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 20204) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: KY 20204) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: KY 2020) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2008-12-11 |