| NPI | 1356632491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NV 26467) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD449590) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2024-10-21 |