| NPI | 1407268386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: MS 26654) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS T-2804) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2022-09-01 |