| NPI | 1689786840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: CA A78168) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A78168) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-02-06 |