| NPI | 1982014213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: LA 333103) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351032354) |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2024-06-07 |