| NPI | 1104054162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CO CDRH.0069369) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MO 2017037935) |
| 2086S0129X Surgery, Vascular Surgery (Licence: KY C0938) | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2022-09-27 |