| NPI | 1538159983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: KS 0447181) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: OH 35039917) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2023-06-01 |