| 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 |