| NPI | 1114188455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: VA 0101253936) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: NH 20465) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2020-08-12 |