| NPI | 1659576700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: OK 34715) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2013-02425) |
| 208600000X Surgery (Licence: OK 34715) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2019-08-02 |