| NPI | 1104055128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: LA 326457) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D74773) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-07-12 |
| Last Update Date | 2021-06-22 |