| NPI | 1205226255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: LA 308626) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA 25MA09725200) |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2020-02-18 |