| NPI | 1619460631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: NM MD2025-0587) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 010021) |
| 208600000X Surgery (Licence: NM MD2025-0587) | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2025-07-14 |