| NPI | 1144587841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME153952) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX R3188) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2022-06-14 |