| NPI | 1447542840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WI 74897) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME134600) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2021-09-21 |