| NPI | 1659717726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: AZ 65019) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP1-0046047) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2023-09-25 |