| NPI | 1790749737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 12458) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: WV 12458) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: WV 12458) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2007-07-09 |