| NPI | 1740625540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: OH 35.140330) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.140330) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2020-10-28 |