| NPI | 1902980410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TX D7249) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX D7249) |
| 2086S0120X Surgery Pediatric Surgery (Licence: TX D7249) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2013-09-06 |