| NPI | 1700129574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: PA MD474278) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: WV 176) |
| 208600000X Surgery (Licence: SC 38355) | |
| Enumeration Date | 2013-03-31 |
| Last Update Date | 2021-08-09 |