| NPI | 1235753153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MD D0100806) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MA 285088) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 1062) | |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2024-08-06 |