| NPI | 1205875739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: GA 58886) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MA 223875) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2020-09-15 |