| NPI | 1083997381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX P6512) |
| Additional Taxonomies | 208600000X Surgery (Licence: PR 28633R) |
| 208D00000X General Practice (Licence: TX P6512) | |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2021-11-09 |