| NPI | 1679992382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: PA OS021595) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: PA FC8331605) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2024-09-13 |