| NPI | 1366485716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: KY 04184) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: IN 02006846A) |
| 2086S0129X Surgery, Vascular Surgery (Licence: OH 34-00-8221-K) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2022-07-13 |