| NPI | 1699032243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2020-03462) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NC 2020-03462) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2021-04-01 |