| NPI | 1942612643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: NC 2019-02931) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL36659) |
| 2086S0129X Surgery Vascular Surgery (Licence: TN 4815) | |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2024-02-29 |