| NPI | 1609165927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: PA MD455865) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A126940) |
| 208600000X Surgery (Licence: OH 57.018612) | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2021-07-15 |