| NPI | 1679855290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: VA 0101252015) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MD439173) |
| Enumeration Date | 2011-09-10 |
| Last Update Date | 2021-06-29 |