| NPI | 1396973962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CO DR.0059629) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD436845) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2021-05-23 |