| NPI | 1205954393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: CT 61850) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VT 0600003444) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2018-09-04 |