| NPI | 1558355511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: TN 34700) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: UT 8186235-1205) |
| 2086S0129X Surgery Vascular Surgery (Licence: AK 116955) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2019-04-15 |