| NPI | 1386739605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A90305) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: CA A90305) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-12-15 |