| NPI | 1164406039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NY 248249) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME90927) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2021-02-25 |