| NPI | 1174962369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: OR MS204777) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R73897) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2021-10-13 |