| NPI | 1720178536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: PA MD427835) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: VA 0101262871) |
| 2086S0129X Surgery Vascular Surgery (Licence: OH 35.090188) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2018-03-17 |