| NPI | 1306285325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: AZ 57400) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MO 2013018941) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2021-11-11 |