| NPI | 1750590998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: SD 7960) |
| Additional Taxonomies | 208600000X Surgery (Licence: SD 7960) |
| 208600000X Surgery (Licence: IA 38406) | |
| 208600000X Surgery (Licence: MN 51981) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2018-06-12 |