| NPI | 1396185328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: NY 304899) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 60607) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2020-07-20 |