| NPI | 1215047659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA G79576) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G79576) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2019-11-06 |