| NPI | 1760744916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MO 2019022904) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R73447) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2019-08-20 |