| NPI | 1316062094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: FL ME172026) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: IL 036131423) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: OH 35.150231) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2025-06-04 |