| NPI | 1174621767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 24263) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 9500519) |
| 2086S0129X Surgery Vascular Surgery (Licence: SC 24263) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-01-30 |