| NPI | 1093235095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MS T-4681) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT017747) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2024-04-12 |