| NPI | 1104055839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WI 68978) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 68978) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2024-06-21 |