| 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 |