| NPI | 1720042864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: CA A75917) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A75917) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2012-06-05 |