| NPI | 1811010903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 285568) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: MA 254947) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2016-09-02 |