| NPI | 1265414411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: OH 35.139103) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 45540) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2022-03-03 |