| NPI | 1780948802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: GA 67690) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 67690) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2026-08-05 |