| NPI | 1063514321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: TX V0258) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A90536) |
| 2086S0129X Surgery Vascular Surgery (Licence: CA A90536) | |
| 2086S0129X Surgery Vascular Surgery (Licence: SC 87410) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2024-06-03 |