| NPI | 1730492414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NV 18566) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ AE3307875) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2022-02-24 |