| NPI | 1164422325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME124619) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA md024651E) |
| 2086S0129X Surgery, Vascular Surgery (Licence: PA md024651E) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2019-07-10 |