| NPI | 1790750057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: GA 111510) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD063704L) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2026-05-08 |