| NPI | 1376537043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MO 2016009821) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 28667) |
| 208600000X Surgery (Licence: MO 2016009821) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: KY 28667) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2021-03-11 |