| NPI | 1386059178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: TX T3759) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX T3759) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL U04302) | |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2021-10-22 |