| NPI | 1912970773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX J5139) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX J5139) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2017-05-05 |