| NPI | 1467862904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 30417) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: WV 30417) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2021-11-17 |