| NPI | 1174802334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX R8499) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 125715) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2023-10-11 |