| NPI | 1306135579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: CA A123518) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: CA A123518) | |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2021-07-20 |