| NPI | 1114929395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101230821) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: WV 30175) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2021-09-16 |