| NPI | 1578791307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TN 55885) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 55885) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN 088001605) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2022-07-21 |