| NPI | 1881956316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: CA A171421) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA L-252146) |
| 208600000X Surgery (Licence: CA A171421) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2024-04-29 |