| NPI | 1720373509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD184094) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60631157) |
| 208600000X Surgery (Licence: TX BP10040007) | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: WA MD60631157) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2026-01-05 |