| NPI | 1558795377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: KY 47747) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD470322) |
| 208600000X Surgery (Licence: KY 47747) | |
| 208600000X Surgery (Licence: OH 35.141595) | |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2023-12-12 |