| NPI | 1982164372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: CT 77740) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2024-06-25 |