| NPI | 1578053492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TN 68987) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: PA MT215165) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2023-10-04 |