| NPI | 1891108700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: LA 339240) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2022-01360) |
| 208600000X Surgery (Licence: LA 339240) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2024-02-26 |