| NPI | 1962500900 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: MI 4301087166) | 
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: SC 36390) | 
| Enumeration Date | 2006-09-21 | 
| Last Update Date | 2021-07-15 |