| NPI | 1528335775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: PA MD446148) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CA F5675) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2012-10-10 |