| NPI | 1922593664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: OH 35.140283) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT216920) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.248539) | |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2023-06-30 |