| NPI | 1386763332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: VA 0101266756) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: MI 4301083699) |
| 2086S0129X Surgery Vascular Surgery (Licence: MI 4301083699) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2021-01-28 |