| NPI | 1679670483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: AZ 35027) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: CA AO69091) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2018-03-17 |