| NPI | 1922206804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: OH 35124390) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101251535) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NA) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2018-03-14 |