| NPI | 1902359680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 275010) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: MA 275010) | |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2020-01-30 |