| NPI | 1497103832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: IL 036.165202) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301109412) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2023-08-02 |