| NPI | 1174020382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: UT 13289387-1204) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5151012245) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2023-03-04 |