| NPI | 1780606905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX K7057) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: TX K7057) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TX K7057) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2021-04-12 |