| NPI | 1558347278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MO 2024047702) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND 20177) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: MT 81033) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2025-01-30 |