| NPI | 1245203454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301044171) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MI 4301044171) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2020-10-23 |