| NPI | 1679835268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NY 297578) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R73261) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2019-06-10 |