| NPI | 1417033739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: LA 201869) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 054561) |
| Enumeration Date | 2006-10-29 |
| Last Update Date | 2021-01-27 |