| NPI | 1750380911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101236718) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: DC 34988) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2023-08-03 |