NPI | 1316610959 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: IA R12428) |
Additional Taxonomies | 208600000X Surgery (Licence: MI 4351048232) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351048232) | |
Enumeration Date | 2021-07-29 |
Last Update Date | 2022-06-27 |