| NPI | 1720375348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: TX R8240) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX R8240) |
| Enumeration Date | 2011-07-03 |
| Last Update Date | 2019-02-12 |