| NPI | 1639557358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: KY TP670) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101265419) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2025-08-25 |