| NPI | 1891051876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CT 1.066658) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 1.066658) |
| 208600000X Surgery (Licence: OH 35.126981) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: OH 35.126981) | |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2020-08-31 |