| NPI | 1073534897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2006-01019) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: NC 2006-01019) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2021-08-17 |