| NPI | 1720423510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX U0245) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: WV 3306) |
| 2086S0129X Surgery, Vascular Surgery (Licence: MN 68240) | |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2023-02-16 |