| NPI | 1588724504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 17871) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX N9229) |
| 2086S0129X Surgery, Vascular Surgery (Licence: CA A52947) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2023-09-22 |