| NPI | 1447221882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: WI 72865) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 2159) |
| 2086S0129X Surgery, Vascular Surgery (Licence: OH 34.003032) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2020-04-08 |