| NPI | 1760648364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: SC LL 33480) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125051812) |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2021-02-26 |