| NPI | 1619138005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: KY 42654) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 42654) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2021-01-21 |