| NPI | 1780689810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MO 2003012657) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: KS 05-30131) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2020-04-27 |