| NPI | 1760712889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 070035) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX M8500) |
| Enumeration Date | 2010-01-12 |
| Last Update Date | 2021-05-13 |