| NPI | 1487788956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101102774) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101102774) |
| 2086S0129X Surgery, Vascular Surgery (Licence: PA MD448558) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2021-08-24 |