| NPI | 1770882250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: OH 35122465) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH fn2263971) |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2022-06-15 |