| NPI | 1053300319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TN 61503) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: OH 35067907) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2020-12-11 |