| NPI | 1578513396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NM MD2015-0422) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX L3442) |
| 2086S0129X Surgery, Vascular Surgery (Licence: TX L3442) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2015-08-06 |