| NPI | 1124409727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TN 68765) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO DR.0066354) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2023-08-09 |