| NPI | 1619914850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 200600321) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NC 2006-00321) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2022-02-10 |