| NPI | 1205860210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: SC 21273) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 21273) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2020-04-24 |