| NPI | 1013142025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101261045) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MTL001073) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2022-02-17 |