| NPI | 1902975543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: LA 301034) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: VA 0101232814) |
| 2086S0120X Surgery Pediatric Surgery (Licence: NC 2009-01985) | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NC 2009-01985) | |
| 2086S0129X Surgery Vascular Surgery (Licence: LA 301034) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2016-07-01 |