| NPI | 1619355906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 87001) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: SC 87692) |
| 2086S0129X Surgery, Vascular Surgery (Licence: PA MT208212) | |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2022-06-13 |