| NPI | 1245232602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: FL ME173884) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: OH 35-07-2613-K) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2025-07-25 |