| NPI | 1639330475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: WA MD 6014714) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML20008340) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2021-04-30 |