| NPI | 1962411660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101034852) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: VA 01010134852) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2021-11-11 |