| NPI | 1104807627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX K9794) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: TX K9794) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2024-03-05 |