| NPI | 1104262112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: AL 42691) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 30088) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2022-01-12 |