| NPI | 1003100025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA C181243) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT199412) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT199412) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2022-12-02 |