| NPI | 1265815898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: KY 04738) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101021877) |
| 208600000X Surgery (Licence: KY 04738) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2024-02-15 |