| NPI | 1952396897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: FL ME112169) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35-092453) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2013-04-04 |