| NPI | 1376803106 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX R2159) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: TX 566858) |
| Enumeration Date | 2012-05-27 |
| Last Update Date | 2020-03-09 |