| NPI | 1124511399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: KS 04-50892) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-50892) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2025-09-02 |