| NPI | 1194746800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 67021) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: LA 015843) |
| 2086S0129X Surgery Vascular Surgery (Licence: OH 35.142147) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2021-05-25 |