| NPI | 1821746801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R80263) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: AZ R80263) |
| Enumeration Date | 2022-03-17 |
| Last Update Date | 2023-05-23 |