| NPI | 1114020922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: TX M0112) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX M0112) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2022-09-01 |