| NPI | 1043455306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 74207) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: SC 84913) |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2022-09-13 |