| NPI | 1033573753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX R9539) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: TX R9539) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2023-06-16 |