| NPI | 1568486926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA G86322) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G863221) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2022-07-21 |