| NPI | 1366998619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MI 4301507973) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD 2023) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2023-07-08 |