| NPI | 1619210119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 88951) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 37022) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2021-06-17 |