| NPI | 1215303110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: KY 56346) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC MTL002969) |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2022-07-27 |