| NPI | 1023227493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: VA 0101256263) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN MD0000045808) |
| 2086S0129X Surgery Vascular Surgery (Licence: VA 010259263) | |
| 2086S0129X Surgery Vascular Surgery (Licence: NC 2011-01637) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2024-07-23 |