| NPI | 1700134830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA 20A14549) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 20A14549) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2024-07-30 |