| NPI | 1366424509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: IA 36327) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: SC 88773) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2022-10-05 |