NPI | 1710368725 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: MO 2023013922) |
Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: FL OS18918) |
Enumeration Date | 2015-06-16 |
Last Update Date | 2024-05-20 |