| NPI | 1306280128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: VA 0101266005) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101266005) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2020-07-30 |