| NPI | 1588294441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 9632) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 9632) |
| Enumeration Date | 2020-01-20 |
| Last Update Date | 2023-08-14 |