| NPI | 1780943274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: KY 53544) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY NONE) |
| 208600000X Surgery (Licence: KY R3061) | |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2020-12-10 |