| NPI | 1881126746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0116037684) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125070352) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2023-12-24 |