| NPI | 1619905999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: ID M8695) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M8695) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2020-10-06 |