| NPI | 1356590459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MI 5101016323) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101016323) |
| Enumeration Date | 2008-09-12 |
| Last Update Date | 2019-11-06 |