| NPI | 1548657596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: PA MD466506) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA 28208078) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2024-06-18 |