| NPI | 1871960443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 97337) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 288883) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301113197) | |
| Enumeration Date | 2015-08-30 |
| Last Update Date | 2023-10-10 |