| NPI | 1619901584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 2386621) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: TX N7589) |
| 2086S0129X Surgery Vascular Surgery (Licence: NY 2386621) | |
| 2086S0129X Surgery Vascular Surgery (Licence: TX N7529) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2024-09-12 |