| NPI | 1417018862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MT 115356) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MA 29415) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2022-09-13 |