| NPI | 1679543565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 3781319) |
| Additional Taxonomies | 208600000X Surgery (Licence: VI 1307) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: VI 1307) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TN 3781319) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: VI 1307) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: TN 3781319) | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: VI 1307) | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TN 3781319) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2014-08-01 |