| NPI | 1386734101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: OH 35.067757) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: PA MD071027L) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2022-01-18 |