| NPI | 1457120487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NC 001014476) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2024-01-02 |
| Last Update Date | 2024-08-22 |