| NPI | 1720213580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: WA MD60854065) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 257542) |
| Enumeration Date | 2009-05-22 |
| Last Update Date | 2021-10-19 |