| NPI | 1730507856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: CA A196322) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 007089) |
| Enumeration Date | 2014-04-05 |
| Last Update Date | 2026-08-03 |