| NPI | 1649650896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 92918) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL38315s) |
| 208600000X Surgery (Licence: GA 92918) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2023-08-15 |