| NPI | 1518119072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX P2935) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301090398) |
| 208600000X Surgery (Licence: TX P2935) | |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2022-03-19 |