| NPI | 1689012205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: GA 86527) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: KY 04235) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2020-08-18 |