| NPI | 1679141527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX BP10077251) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: IL 125.080062) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2022-05-25 |