| NPI | 1114127123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: VA 0101258480) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: TX N9771) | |
| 207P00000X Emergency Medicine (Licence: TX N9771) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2015-07-16 |