| NPI | 1720018138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: SC 18346) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 9900639) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2021-06-08 |