| NPI | 1487851853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MD D73653) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 255105) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2021-10-26 |