| NPI | 1245288893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 45509) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 48319) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 48319) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: KY TP575) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2014-05-16 |