| NPI | 1558658815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MO 2017030523) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R72609) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2022-08-04 |