| NPI | 1891131900 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TX R8773) | 
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP1-0046044) | 
| Enumeration Date | 2013-05-15 | 
| Last Update Date | 2023-08-14 |