| NPI | 1023467461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: TX T2939) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: TX BP10057072) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2024-03-07 |