| NPI | 1689100349 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: MN 79399) | 
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT212903) | 
| Enumeration Date | 2017-05-02 | 
| Last Update Date | 2025-05-19 |