| NPI | 1265621635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: TN 51515) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: PA MD 445503) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2023-09-18 |