| NPI | 1649493750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA A74562) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A74562) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2023-03-07 |