| NPI | 1821204041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: AZ 005077) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 005077) |
| 208600000X Surgery (Licence: MI 5101015324) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2022-12-02 |