| NPI | 1942647425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: AZ 59231) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R73900) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2021-06-03 |