| NPI | 1205192614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: CA A120700) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A120700) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2023-09-04 |