| NPI | 1255692877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101262651) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101262651) |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2019-09-10 |