| NPI | 1790984375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: NC 2012-00656) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 2012-00565) |
| 208600000X Surgery (Licence: NC 2012-00656) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2021-11-03 |