| NPI | 1164765996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: KS 04-45754) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 7022) |
| 208600000X Surgery (Licence: KS 04-45754) | |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2024-03-13 |