| NPI | 1942562863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 97125) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101271037) |
| 208600000X Surgery (Licence: MI 4601500938) | |
| 208600000X Surgery (Licence: OH 35131760) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101271037) | |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2023-10-02 |