| NPI | 1396189726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX R6628) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 07551668) |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2022-01-25 |