| NPI | 1023037348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101258172) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2011-01858) |
| 208600000X Surgery (Licence: SC 29136) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-02-28 |