| NPI | 1235121989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: MI 4301058472) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI WR05847) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2023-01-31 |