| NPI | 1578396297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NC 0010-14474) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-14474) |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2024-09-24 |