| NPI | 1629167622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: KY 50044) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 101470-875) |
| 208600000X Surgery (Licence: WA MD60164818) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2024-04-22 |