| NPI | 1104153063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 085351) |
| Additional Taxonomies | 208600000X Surgery (Licence: MT MED-PHYS-LIC-103773) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208600000X Surgery (Licence: GA 085351) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: MT MED-PHYS-LIC-103773) | |
| Enumeration Date | 2009-11-12 |
| Last Update Date | 2024-01-30 |