| NPI | 1801858675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: PR 9930) |
| Additional Taxonomies | 208600000X Surgery (Licence: PR 9930) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2017-03-10 |