| NPI | 1457682924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: LA 305925) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: LA Pending) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-01-23 |
| Last Update Date | 2018-03-17 |