| NPI | 1467455295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 29539) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: NC 29539) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2023-08-01 |