| NPI | 1891216602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: UT 14216543-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 8029) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2025-07-18 |