| NPI | 1760465652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: MA 72269) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 72269) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2012-07-19 |