| NPI | 1063788248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2023-02287) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2086S0129X Surgery, Vascular Surgery (Licence: TN MD62971) | |
| Enumeration Date | 2012-04-01 |
| Last Update Date | 2024-03-06 |