| NPI | 1942659016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: CA A176442) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208600000X Surgery (Licence: HI MD19764) | |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2024-09-10 |