| NPI | 1679766745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: PA MD446301) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 274616) |
| 208600000X Surgery (Licence: PA MD446301) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2018-12-18 |