| NPI | 1215164959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: OH 35137630) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301500924) |
| 208600000X Surgery (Licence: OH 35137630) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: MN 59646) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: MI 4301500924) | |
| Enumeration Date | 2009-06-21 |
| Last Update Date | 2023-11-03 |