| NPI | 1417270356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL OS13230) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT012635) |
| Enumeration Date | 2010-03-06 |
| Last Update Date | 2023-10-02 |