| 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 |