| NPI | 1104818103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MA 58121) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 58121) |
| 208600000X Surgery (Licence: VA 0101254593) | |
| 208600000X Surgery (Licence: TN 48573) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: TN 48573) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101254593) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2022-03-08 |