| NPI | 1952745242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2018-00676) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: NC 2018-00676) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2024-05-04 |