| NPI | 1609187889 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: GA GA69904) | 
| Additional Taxonomies | 208600000X Surgery (Licence: GA 66904) | 
| Enumeration Date | 2010-06-23 | 
| Last Update Date | 2025-07-14 |