| NPI | 1801061510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME164503) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 122175) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2023-10-30 |