| NPI | 1891050969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: TX T1340) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 005665) |
| 2086S0129X Surgery Vascular Surgery (Licence: SD 13692) | |
| 2086S0129X Surgery Vascular Surgery (Licence: IA MD-50824) | |
| 2086S0129X Surgery Vascular Surgery (Licence: MN 72604) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2025-07-16 |