| NPI | 1861920951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: KY 56774) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: SC LL40920) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2022-07-21 |