| NPI | 1730134644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME0041529) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: TX G4046) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2020-03-04 |