| NPI | 1922458892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MO 2022046851) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: AZ 62608) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2022-12-12 |