| NPI | 1649279431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL 67029) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: KY 28226) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2019-01-14 |