| NPI | 1164412862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: ID M-12372) |
| Additional Taxonomies | 208600000X Surgery (Licence: WY 6720A) |
| 208600000X Surgery (Licence: NC 2018-01195) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: WY 6720A) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: FL ME153722) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2023-10-24 |