| NPI | 1831304724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX N3551) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301082154) |
| 208600000X Surgery (Licence: TX N3551) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2019-04-18 |