| NPI | 1871974386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME157706) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA L-264060) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2024-10-25 |