| NPI | 1528122942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: WA MD00024749) |
| Additional Taxonomies | 174400000X Specialist (Licence: KS 04-27080) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2013-08-26 |