| NPI | 1750495628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A24647) |
| Additional Taxonomies | 2086S0129X (Licence: CA A24647) |
| 208D00000X General Practice (Licence: CA A24647) | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: CA A24647) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2025-09-11 |