| NPI | 1578913802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CO DR.0061137) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO DR.0061137) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL 0006308) | |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2023-10-09 |