| NPI | 1568849602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: FL ME165988) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10052960) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2024-03-12 |