| NPI | 1508887068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NC 200601485) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2006-01485) |
| 2086S0129X Surgery, Vascular Surgery (Licence: MD d0062370) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2024-11-20 |