| NPI | 1558752865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: UT 12099235-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25ma10055400) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2021-03-23 |