| NPI | 1902872799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 87798) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: NM MD2005-0443) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2022-11-23 |