| NPI | 1710981444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: MO 103971) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 103971) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2022-07-22 |