| NPI | 1962407007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TX M5000) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: WA MD70045957) |
| 208600000X Surgery (Licence: LA 15238R) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2025-09-15 |