| NPI | 1679763114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: LA MD.202912) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: LA 202912) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2020-02-18 |