| NPI | 1003857491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX U6782) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX U6782) |
| 2086S0129X Surgery, Vascular Surgery (Licence: PA MD068000L) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2023-12-15 |