| NPI | 1912215609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX S8089) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 46742) |
| 2086S0129X Surgery, Vascular Surgery (Licence: KY 46742) | |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2022-09-01 |