| NPI | 1992142509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2014014078) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: WV 29424) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN18740) | |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2022-04-08 |