| NPI | 1780804856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: CO CDR0001845) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2004016730) |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2024-02-15 |