| NPI | 1881959005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CO DR.0061771) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD P29788) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2019-08-05 |