| NPI | 1912101403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: AZ 68986) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 47350) |
| 208600000X Surgery (Licence: CT 54114) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2023-07-15 |