| NPI | 1760411656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NC 2018-02023) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101240963) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2021-03-15 |