| NPI | 1962660936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: MA 247016) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 233575) |
| 2086S0129X Surgery, Vascular Surgery (Licence: DC 102688) | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2021-08-17 |