NPI | 1164636783 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME 107124) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
2086S0129X Surgery, Vascular Surgery (Licence: PA MD438171) | |
Enumeration Date | 2007-05-10 |
Last Update Date | 2013-08-23 |