| NPI | 1508359936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA A183690) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.071766) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2023-06-19 |