| NPI | 1720075385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 29446) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: WI 29446) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2021-12-01 |