| NPI | 1992125272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 34817) |
| 2086S0129X Surgery, Vascular Surgery (Licence: OK 34817) | |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2021-07-12 |