| NPI | 1760697783 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: AR E-14776) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 56370) |
| 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101247398) | |
| Enumeration Date | 2007-05-12 |
| Last Update Date | 2021-10-12 |