| NPI | 1801112503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: LA 207675) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: NY 269236) |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2016-01-07 |