| NPI | 1780847400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: MD D82992) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301091950) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2022-07-21 |