| NPI | 1831204510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: AZ 55625) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 230074) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2020-09-08 |