| NPI | 1578823043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: MA 257325) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MA 257325) |
| 2086S0129X Surgery, Vascular Surgery (Licence: TX U0799) | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2022-12-07 |