| NPI | 1235541640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: OH 35.139827) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: PA MT206551) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2020-07-01 |