| NPI | 1467714824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: OH 35.130473) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.130473) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2023-10-10 |