| NPI | 1730160706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TX L5981) |
| Additional Taxonomies | 2086S0129X (Licence: MA 223625) |
| 2086S0129X (Licence: TX L5981) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2026-07-10 |