| NPI | 1679795603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GU M-1017) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: GU M-1017) |
| 2086S0129X Surgery, Vascular Surgery (Licence: GU M-1017) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2023-03-07 |