| NPI | 1538783501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA R-11943) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: IA MD54913) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2025-05-15 |