| NPI | 1558742486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NE 32590) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: MO 2015017604) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2020-09-14 |