| NPI | 1811359995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: AK 156070) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 19112) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2022-08-12 |