| NPI | 1912523036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246XC2903X Spec/Tech, Cardiovascular, Vascular Specialist |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2025-06-09 |