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 |