| NPI | 1679819031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: MA 4066) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: ME 010688) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: ME 010688) | |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2018-08-28 |